O-028 Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombolysis of acute ischemic strokes
Bibliographic record
Abstract
Purpose The Penumbra Pivotal Stroke Trial reported a 25% good outcome rate (modified Rankin Scale (mRS) ≤2) despite 81% recanalization rate. We evaluated whether a good initial non-contrast CT (Alberta Stroke Programe Early CT Score (ASPECTS) >7) and a short time to recanalization predicted good clinical outcome in this trial. Materials and methods Data were from the Penumbra Pivotal Stroke Trial. Baseline scans were evaluated by two experienced readers blinded to clinical outcomes using an ASPECTS scoring system. ASPECTS was dichotomized into >7 and ≤7 for the primary analysis. Data on the degree of recanalization based on TIMI scores, stroke onset to recanalization time and CT to recanalization time were obtained. The primary clinical outcome was mRS ≤2 at 3 months. Results Median baseline NIHSS was 18 (range 8–34) and median baseline ASPECTS was 6 (range 0–10). 81.2% achieved recanalization (TIMI 2–3) and 27.1% good clinical outcome. There was no difference in baseline characteristics between the groups with ASPECTS >7 and ≤7 except in history of hypertension (more common in the >7 group, p=0.01). No difference in TIMI 2–3 recanalization (83.9% vs 79.6%; p=0.8), onset to recanalization (390 vs 359 min; p=0.6) or CT to recanalization time (223.8 vs 208 min; p=0.6) was noted between these two groups. Good clinical outcome however was significantly higher in the >7 group compared with the ≤7 group (50% vs 15%, risk ratio 3.3, 95% CI 1.6 to 6.8; p=0.0001). No patient with an ASPECTS score ≤4 (n=28) or without recanalization (TIMI 0–1) (n=16) had good clinical outcome. There was evidence of an interaction between baseline ASPECTS (dichotomized as >7 and ≤7) and onset to recanalization time (dichotomized as ≤300 min and >300 min) in predicting good clinical outcome (p=0.06). Conclusion Patients with a low baseline CT (ASPECTS ≤4) do not benefit from recanalization at any time point. Patients who do not recanalize do not benefit at all. Fast recanalization may benefit even patients with evident damage on the CT scan (ASPECTS >4). Only patients with very favorable scans (ASPECTS >7) benefit when recanalization is late. Patients benefit the most when they are recanalized rapidly and have a favorable baseline CT scans (ASPECTS>7).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".